Beyond Belief: How Evidence Shows What Really Works, by Helen Pearson

• Category: Non-fiction
• Rating: 4 out of 5
• Tags: Decision-making, Evidence, Meta-analysis, Statistics, Systematic reviews
• How I learned about it: Author interview on Nature podcast

I might have to retract my criticisms of the medical industry for its late adoption of evidence-based decision-making, which only started in the 1970’s and didn’t really take off until the 1990’s.  It’s a late start for a discipline rooted in science, and what the heck were they using before?  It turns out there’s more to it than I thought.

Pearson tells how evidence-based decision-making was adopted in various fields by following the people who helped to lead the change.  The story quickly becomes familiar – someone new to the field notices there’s little evidence to justify what’s considered best practice, so it falls to the most senior (or the loudest) person in the room to decide how it’s done.  Justifications range from “we’ve always done it that way,” to “the textbook says to do it that way,” or “I read it in last month’s journal.”  There was no systematic way of gathering evidence to decide what was best.  This was true in medicine, social policy, policing, environmental conservation, business management, and education.

It’s a no-brainer to base decisions on evidence, but finding, assessing and summarizing that evidence is hard.   For one thing, randomized controlled trials weren’t widely used in medicine until the 1960’s or 1970’s.  The data just wasn’t there.  And there are different kinds of evidence, from large, high quality randomized controlled trials to lab-based research results.  Trials can have different sizes, methods and ways of measuring results, so are hard to combine.  Finding the data requires searching journals and theses, which used to mean paging through paper copies in the library.  The relevance and quality of the studies have to be assessed, the data extracted and merged, and conclusions summarized.

Meta-analysis and systematic reviews may sound routine now, but it wasn’t until the mid-1970’s that statisticians figured out a way to combine the results of different studies.  It was an exciting development, as researchers realized they could finally “extract meaning from a mountain of similar studies.”

Like any innovation that challenges established practice, there was opposition – experts don’t like being challenged with evidence.  Evidence can reveal “uncomfortable truths”, like the fact that most social programs don’t help.  Of course, we can only discover this if policies are studied to see if they work (or even cause harm), and most are not evaluated.  It’s the same for environmental conservation efforts, partly because field experiments are so difficult.  And for business management, which is “a largely evidence-free zone,” there are tons of books and articles touting the flavour of the week, but it’s even harder to experiment on humans than on the environment, so there’s little in the way of follow-up studies to show which practices are the best.

We can be grateful to the statisticians who figured out how to combine disparate data.  It’s more exciting, and easier to get funding, to do a new study than to gather existing data from dusty archives, so we should also be grateful to those dedicated to finding, assessing, combining, and summarizing the results of multiple studies.  It’s getting easier now with internet search and AI summarizing capabilities, but it’s still a daunting task.

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The Decline and Fall of the Human Empire: Why Our Species Is on the Edge of Extinction, by Henry Gee

• Category: Non-fiction
• Rating: 3 out of 5
• Tags: Extinctions, Human Species
• How I learned about it: Book reviews in the New York Times and Forbes.

All species on earth eventually go extinct, or at least they have so far.  The question is whether Homo Sapiens is special enough that it can avoid the fate of all the others.  Henry Gee thinks not, unless we take advantage of a narrow window of opportunity to become a multi-planetary species.

One risk factor is our low genetic diversity.  Around 900,000 years ago, genetic studies tell us there were never more than 1280 humans available for reproduction for over 100,000 years.  This genetic choke-point has left us vulnerable to disease.  Similarly, most of us now rely on a few genetically similar agricultural crops; the lack of diversity makes our food supply less resilient.

Another indicator is the human population forecast, which shows a peak in our numbers sometime this century.  Species usually expand to the limits of their environmental niche, then die back.  Our population will peak just as the consequences of climate change worsen, increasing competition for resources like farm land and water.  Humans have dominated the earth to a shocking degree:  “It has been estimated that between 25 and 40 percent of all the products of photosynthesis by green plants on earth have been sequestered by humans.  Homo Sapiens and its domestic animals comprise 96 per cent by mass of all mammal species.”

There is hope.  Artificial improvements to photosynthesis could improve plant productivity.  Switching from a meat-based to a plant-based diet would use food from plants more efficiently.  Or humans could learn to live in space or on other planets, creating reservoirs of human life from which to repopulate earth after a major disaster, or even evolve separately from the main population and eventually add genetic diversity to the species.

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Bonk: The Curious Coupling of Science and Sex, by Mary Roach

• Category: Non-fiction
• Rating: 4 out of 5
• Tags: Biology, Human Sexuality, Sex Research
• How I learned about it: The book by Mary Roach that I was looking for, Replaceable You, was not available at my library, but this one was.

This is a look at the history of research into human sexuality.  Although humorously presented, Mary Roach’s research for the book is thorough to the point of obsession.  She convinced her husband to travel to London with her to have sex while undergoing “dynamic 3D ultrasound imaging.”  When she learned that Masters and Johnson had created an artificial penis, complete with lights and camera, she immediately asked if she could see it, or a film of it in action, or even footage taken with it.  Unfortunately, the instrument and footage have all been destroyed, so Roach had to make do with attending an event put on by the Center for Sex and Culture, called Sex Machines: Book Talk, Slide Show and Machine Play Party.

Details about the intimate behaviour of people were being recorded long before Kinsey or Masters and Johnson began their ground-breaking research.  Gynecologist Robert Dickinson took sexual detailed histories of his patients starting in 1890, seeing a need to improve marital relations.  In the 1930’s, Ernst Boas and Ernst Goldschmidt took heart rate measurements of research subjects during sex (it goes up), and documented a woman’s multiple orgasms well before Kinsey reported them.

Kinsey’s data came mostly from interviewing large numbers of people about their sexual behaviour, but also from direct observation – conducted not in a research lab, but in the attic of his home.  The sessions were filmed by a commercial photographer hired for the purpose.  To ensure secrecy, the subjects were mostly Kinsey’s own staff members and their wives.  Demonstrating her usual commitment to thorough research, Roach asked the Kinsey Institute if she could see the films, but unfortunately, they were “not available.”

William Masters began his study of human sexual physiology in 1954.  Masters was a gynecologist at Washington University in St. Louis.  He obtained funding and permission for the research by presenting it as objective and scientific; it helped to hire a female associate, Virginia Johnson.  It was all very proper, conducted under the Reproductive Biology Research Foundation, in a lab, by professionals in lab coats using scientific instruments.  However, as Roach puts it, “…at the core of it, you had couples fornicating on film.”

There’s lots more, including more recent research into the effects of hormones, treatments for various forms of dysfunction, and how to “do it” better.  Unlike a book on fun that wasn’t fun, and a book on humour that wasn’t funny, this book is both fun and funny.

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Beneath the Surface of Things: New and Selected Essays, by Wade Davis

• Category: Non-fiction
• Rating: 4 out of 5
• Tags: America, Culture, Essays
• How I learned about it: Recommended by a friend.

Not all of these thirteen essays by Wade Davis justify a rating of 4 out of 5, but the ones that do are good enough to carry the rating for the entire book.  We start with “This is America”, which makes the case that America is built on slavery and racism.  The war on drugs, declared by Richard Nixon purely as a political ploy, has not only been an abject failure, but has intentionally caused a disproportionate number of African Americans to be sent to prison for drug offenses.  Describing the behaviour of Donald Trump, Davis does not pull his punches, accusing Trump of overt racism.  In one case from 1989, lawyers “compared Trump’s actions to a call for lynching.”

Racism in America has softened, at least in some area of life, as Davis recounts in “Why Anthropology Matters.”  Interracial marriage was made legal across the US in 1967, and false theories about the inferiority of Black people are no longer held true by respected researchers.  The change in attitudes came in part from new scientific results – sequencing the human genome proved that race is a fiction – and from the work of anthropologists like Franz Boas, who valued each culture as “a unique answer to the fundamental question: What does it mean to be human and alive?”

Davis tackles some serious and difficult topics – the conflict between Israel and Palestinians; the sorrow and legacy of the First World War; indigenous relations; climate change; and problems with America like gun culture, the cult of the individual, police violence against Blacks, economic inequality, and political polarization.  Trump “lives to cultivate resentments…his main tool of governance is the lie…”.  Canada suffered half the morbidity and mortality rates from COVID that the US experienced, because of our stronger social contract.  “The measure of wealth in a civilized nation is not the currency accumulated by the lucky few, but rather the strength and resonance of social relationships and the bonds of reciprocity that connect all people in common purpose.”

Others topics are somewhat lighter – early efforts to summit Mount Everest; and the foolishness of banning coca, “the divine leaf of immortality,” which could be used to make tea or in gum to create an industry, eliminate a whole branch of criminal activity, and become Columbia’s gift to the world.

Thoughtful, well-researched, and well-written, these are essays worth reading.

 

 

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The Soul of Wealth: 50 Reflections on Money and Meaning, by Daniel Crosby

• Category: Non-fiction
• Rating: 4 out of 5
• Tags: Happiness, Investing, Saving, Wealth
• How I learned about it: Recommended on the podcast The Free Lunch by Canvas Wealth

This book is intended as “a guide to spending, saving, investing, and giving in ways that enrich life.”  It’s a recognition that money is not an end in itself; that there are other, richer aspects of life that we need to focus on as well.  Enjoyment of life comes not from the size of our bank accounts, but from the strength of our relationships; the engagement, meaning, and sense of accomplishment we find in work; and the fun we have along the way.

Much of the book focuses on developing good savings and investing habits, but part is about how to use money to increase life satisfaction, summarizing the latest research on happiness.

Money, compared to its absence, can certainly reduce misery, and if spent wisely can buy us contentment, if not happiness.

From The Top Five Regrets of the Dying, by Bronnie Ware, we learn we should work less, be true to our values, express our feelings, sustain close friendships, and let ourselves be happier.  One of the things that makes you happier is giving to others.  The emphasis is on people and experiences over things.  Finally, don’t compare yourself to others – the Jones may not be as happy as they appear.

Money is a tool, and when used to avoid tasks you dislike, to do things you enjoy, to improve relationships, and for self-improvement, it can, sort of, sometimes, buy happiness.

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The Frackers: The Outrageous Inside Story of the New Energy Revolution, by Gregory Zuckerman

• Category: Non-fiction
• Rating: 3 out of 5
• Tags: Fracking, Oil and Gas Exploration and Development
• How I learned about it: Recommended by a friend.

You know right from the start that you’re going to be meeting some interesting characters, when a Texas rancher is described as using “a walking stick made from the manhood of a two-thousand-pound Brahma bull.”  This rancher’s financial difficulties ended when the oil rights under his land were leased by a large oil company that wanted to drill into the shale under his land.

Organically rich shale had always been considered a source rock, slowly leaking oil and gas into more porous reservoir rocks like sandstone.  Shale was always thought to be too “tight,” too low in porosity and too impermeable for oil and gas to flow into a well bore at anything like the rates required to be worth drilling for.  Persistent experimentation by explorationists in the US has changed that thinking, turning previously inaccessible oil and gas deposits into valuable reserves.

It took 17 years for George Mitchell of Mitchell Energy to figure out how to get gas from shale, and not much oil came out of the Bakken in North Dakota until 2007.  Oil companies risked vast amounts of money, leasing huge tracts of unproven land, hoping the new technology would work and make oil and gas flow from the tight rock.  When it did, it made some oilmen into billionaires.

Three innovations led to success.  First, fracking the tight rock by pumping a mixture of water, chemicals and sand into the well bore under high pressure.  The chemicals control the viscosity of the water, and the sand holds open the fractures created by the high-pressure fluid.  Second, directional and horizontal drilling allows the well bore to follow an oil or gas-bearing zone for up to several kilometers, exposing more of the well bore to the reservoir rock.  Finally, multi-stage fracs, in which selected zones are isolated and fracked one at a time, in sequence, for focussed stimulation of multiple intervals along the well bore.

Environmental concerns are valid.  The chemicals that come back out of the well need to be disposed of properly; aquifers need to be protected, and tested before and after drilling.  While an outright ban on all fracking is not justified, strong regulation and enforcement is required.

The revolution in oil and gas production has geopolitical consequences: thanks to shale gas and shale oil, the US is now a net exporter of petroleum products, a position it has not held since 1949.  No longer having to worry about keeping the oil flowing from foreign producers, energy independence gives the country “more flexibility to conduct policy as it sees fit.”

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Atlas of the Heart: Mapping Meaningful Connection and the Language of Human Experience, by Brené Brown

• Category: Non-fiction
• Rating: 3 out of 5
• Tags: Emotions, Psychology
• How I learned about it: Author interview on The Happiness Lab podcast

Who among us can name more than a few emotions?  Do you realize that resentment stems from envy, not anger?  Can you articulate the differences between awe and wonder; curiosity and interest; hopelessness and despair; pity and compassion; calm and contentment?  Did you know that perfectionism is driven by shame, asking, “what will people think?” rather than an internal desire for excellence?

Brené Brown’s research shows that people can’t name most of the emotions they feel.  On average, they can identify only three – happy, sad, and angry.  The nuances matter, because without the words to describe what we’re feeling, it’s hard to understand and regulate our behaviour.  “Language is our portal to meaning-making, connection, healing, learning and self-awareness.”

More than a list of definitions, the book reveals the impact emotions can have when they’re not recognized or understood.  With the heft and solidity of a reference book, Atlas of the Heart is a revealing map of human emotions.

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Enshittification: Why Everything Suddenly Got Worse and What to Do About It, by Cory Doctorow

• Category: Non-fiction
• Rating: 4 out of 5
• Tags: Big Tech, Internet Platform Degradation
• How I learned about it: Recommended by my brother.

Cory Doctorow has coined a word that’s fun and naughty to say, but describes a serious degradation in the services we’ve come to rely on.  The “everything” in the title really means the internet and its platforms, like Facebook, Amazon, and Twitter (now X).

At first, these services were great.  Facebook, for example, used to promise that it wouldn’t spy on you, and would connect you only to the people you wanted to be connected to.  This is Stage One of enshittification: being good to customers.  Then (Stage Two) it sold your data to advertisers and allowed them to target you in their ads, and to publishers who could pay to promote their content in your feed.  Finally (Stage Three), it cheated the advertisers paying to reach interested buyers, and the publishers trying to reach interested readers.

It’s a similar story with Amazon, Apple, Google and Twitter.  After customers, and then advertisers, vendors and publishers were sucked in with a great product, the platforms changed the deal to squeeze as much profit as possible out of the system.

This isn’t just capitalism in action.  Network effects and the cost of switching to better platforms discourage competition, drive consolidation and create giant monopolies.  Regulators failed to act, and are subject to influence by well-funded lobbyists, being “captured” by monopolistic companies – instead of protecting consumers, regulators became supporters of Big Tech.  Intellectual property laws prevent users from modifying or repairing devices or writing software to make things better.  Ethical tech workers who used to hold the line no longer benefit from an employees’ market, so don’t speak up.

It’s getting a little better, as the European Union has enacted legislation to rein in the big tech companies.  Some tech workers are forming unions, and the appetite for anti-trust enforcement in the US has increased.  Legislators and regulators could require tech companies to make it easier to change service providers, dramatically reducing the cost of switching, and could act to strengthen privacy rights.  On an individual level, you could use alternatives to Twitter and Facebook like Mastodon, which allows users great control over who they interact with, and makes it easy to switch between Mastodon servers by exporting all the links from their old account.  You could switch to a search engine like Kagi.com, a subscription-based service that doesn’t downgrade your search results (to make you search again and see more ads), or promote paid content, like Google does.  Doctorow says, “After years of rapidly declining Google Search quality, using Kagi was almost sorcerous.”

As Doctorow puts it, “We can reverse the enshittification of the internet.  We can halt the creeping enshittification of every digital device,” and build a better system to serve humanity.

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Super Agers: An Evidence-Based Approach to Longevity, by Eric Topol, MD

• Category: Non-fiction
• Rating: 4 out of 5
• Tags: Health, Longevity
• How I learned about it: Episode of CBC Radio’s White Coat, Black Art with Dr. Brian Goldman

I heard about this book on an episode of White Coat, Black Art with Dr. Brian Goldman, where it was highly recommended.  The recommendation is supported by a glance at the endorsements on the book jacket, with praise from four Nobel laureates and other highly-ranked researchers and authors.  This is a serious book based on a hard-nosed look at the latest research into human longevity.

Topol covers much of the same ground as other books on longevity, with a focus on what we can do now to extend lifespan and health span, starting with lifestyle risk factors.

Avoiding risk factors like smoking, high alcohol consumption, obesity, poor diet, loneliness and inadequate exercise can add around seven to ten years to our lives (or even, in one study, over twenty years).  Groups with healthy vs unhealthy lifestyles both spend around eight years at the end of their lives with a diagnosis of a major disease like cancer, cardiovascular disease, or type 2 diabetes, but notably, it’s the healthy years that are extended by lifestyle factors, so you’re not just living longer while sick.

One surprise for me was the U-shaped curves of health benefits vs amount of sleep and exercise.  Exercise, including strength training, has wonderful benefits.  At first, your health risk goes down with more exercise, but at the highest levels the risk starts going back up.  The same is true of sleep.  The risk of dementia goes down with increasing hours of sleep, up to just over seven hours.  After that, the risk of dementia goes up again.

Obesity is a major health problem affecting around a billion people worldwide.  Body Mass Index (BMI), is a widely used but inaccurate way to assess obesity, because about one in three people with a normal BMI is obese when body fat is measured.  A DEXA scan (dual-energy X-ray absorptiometry) is an accessible, accurate way to measure body fat, muscle mass, and bone density, and can be used to track progress in weight loss and strength training.

Apart from lifestyle factors, there are some new treatments and diagnostic tools making a difference.

For controlling diabetes and obesity, the GLP-1 class of drugs that includes Ozempic and Wegovy is life-changing.  They seem to have other beneficial effects, too, on inflammation, heart disease, kidney function, Parkinson’s, Alzheimer’s, and cancer.  There are serious drawbacks, however: side effects include nausea, diarrhea, and muscle loss; lifetime use is required; and until pills are developed, they require weekly injections.

Fast, cheap DNA sequencing allows us to create an individualized “polygenic risk score” based on hundreds of genome variants.  People identified as being at higher risk can then have early screening and treatment, reducing the impact of disease before symptoms appear.

While not widely used yet, there is more that could be done now to identify early risk factors for heart disease.  Testing for inflammation markers in the blood, AI analysis of retina scans, smart watches that accurately track heart rhythms, analysis of the gut microbiome, and heart aging estimates (via plasma proteins assessed for aging of specific organs, which age at different rates) could all improve outcomes for heart disease.

The rise of AI has numerous health benefits.  AI retina scans can screen for neurodegeneration; AI speech analysis can predict Alzheimer’s disease; multi-modal AI analysis of one’s whole medical history can aid diagnosis; AI assisted mammogram analysis is better at detecting breast cancer; and AI has helped discover new antibiotics.

Then there are some ideas that haven’t worked out.  Dietary supplements are unproven as a way to improve health span.  Extreme caloric restriction works in rodents, yeast and fruit flies, but has mixed results in non-human primates (however, consistent with the benefits of lifestyle factors, mild caloric restriction of 12-14% significantly reduces biological age in humans).  Measuring telomere length or your epigenetic clock’s biological age is useful for research, but not for individuals.  Transfusion of young blood has no proven benefits in humans, and comes with risks.

New treatments are on the horizon, but require more research and clinical trials before becoming available.  CRISPR gene editing has potentially revolutionary promise in treating many diseases, but so far is limited and prohibitively expensive.  Epigenetic editing also has promise – it was used to treat Creutzfeldt-Jacob disease with programmable methylation, preventing expression of prion proteins.  Partial epigenetic reprogramming could remove the epigenetic signatures of aging.  There may one day be vaccines for cancer and MS.  The drugs rapamycin and metformin show anti-aging effects, and taurine supplements may help.  Bacteriophages could be used to treat diseases not amenable to treatment by antibiotics.

In Topol’s view, before we have any general anti-aging treatments, it’s more likely we’ll develop organ-specific treatments that will extend lifespan.  Perhaps body-wide aging treatments will follow.

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The Undoing Project: A Friendship That Changed Our Minds, by Michael Lewis

• Category: Non-fiction
• Rating: 3 out of 5
• Tags: Bias, Decision-making, Daniel Kahneman, Amos Tversky
• How I learned about it: Saw it in the library.

These days, if you want to explain how data analytics helps make better decisions, you just have to mention Michael Lewis’ 2003 book, “Moneyball.”  It’s become a cultural reference that everyone gets.  The fact that statistics provides better evaluations than those of experts stems from built-in biases and errors to which we’re all prone, as described by Daniel Kahneman and Amos Tversky in their research papers in the 1970’s an 80’s, and in Kahneman’s 2011 book, “Thinking, Fast and Slow.”

Michael Lewis has said he like his books to be driven by interesting characters, and he’s found them here in Kahneman and Tversky.  It’s a biography of two men and their research partnership, and about how the mind works when it’s making judgements and decisions in the face of uncertainty.  It explains why two Israeli’s decided to figure it out, and how Kahneman, a psychologist, won a Nobel Prize in economics.

They identified biases like loss aversion, framing, and anchoring, which are all explained in Kahneman’s book, but here we see how the research was done, and the delight taken by Kahneman and Tversky in the things they learned, by the strange tricks the mind played.  People aren’t rational decision-makers!  They worked together so closely, they lost track of who came up with what idea, and had great fun inventing ways to test new ideas.

The “Undoing Project” of the title refers to an idea to investigate how people imagine alternative scenarios – essentially undoing reality and imagining how things could have been different.  By this point, Kahneman and Tversky were working at different universities, and bitter feelings about assigning credit were undoing their partnership.  They reconciled before Tversky’s death in 1996, and Kahneman won the Nobel Prize in 2002.

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